Governance Models for Multipayer Primary Care Initiative Care Transformation Collaborative of R.I. MMF LEARNING COLLABORATIVE JANUARY 31 ST, 2017 1
Governance Model for Statewide Multi payer Primary Care Initiative 2006 multi payer provider stakeholders group convened by State; 2 year planning grant funded the development of a pilot project. 2008 Pilot program launched (5 practice sites) Steering Committee and 6 Committees to do the work Project charter and work plans were developed (see charter documents) 2010 Pilot program expanded with MAPCP ( 8 practice sites) Executive Committee Formed 2012 Pilot program expanded to increase MAPCP covered live (3 practice sites) Steering committee; Executive Committee; 5 committee (D&E; PTS; PR. Physician Champions; NCMs) 2013 Statewide Program Expansion (32 practice sites) 2015 Pediatric pilot project (9 practices); Adult expansion (25 practice sites ) Incorporated as 501c3; bylaws; Board of Directors (19 large multi stakeholder representation) 2016 CPC+ Statewide (31 practices sites) 2
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Chronic Care Sustainability Initiative (CSI RI) Strategy Map 2013 2018 Vision Rhode Islanders enjoy excellent health and quality of life. They are engaged in an affordable, integrated healthcare system that promotes active participation, wellness, and delivers high quality comprehensive health care. Mission To lead the transformation of primary care in Rhode Island. CSI RI brings together critical stakeholders to implement, evaluate and spread effective models to deliver, pay for, and sustain high quality comprehensive accountable primary care. Increase capacity and access to PCMH Increase access to PCMH practices Improve provider satisfaction Increase recruitment and retention of primary care physicians Institutionalize participation in the learning collaborativeprovide incentives and reimburse provider time for supporting other practices Increase the percentage of patients in CSI PCMHs from 10% of the population to 20% in 2013 Improve quality and patient experience Establish a Patient Advisory Group Continue to measure and improve practice performance on quality metrics Diabetes Hypertension Tobacco Cessation Adult BMI Improve in CAHPS survey: access 53%; communication 82%; and office staff 79% Practices achieve 4 out of 7 quality measures in 2013 Goals Strategies Measures Reduce the cost of care Implement developmental contracts and new payment methodologies (e.g. shared savings) Continue to refine the claims data extract project to include Medicare and Medicaid Consider the impact of new practices on aggregate measures Reduce all cause inpatient admissions by 5% Reduce all emergency department visits by 7.5% Improve population health Expand to include children and behavioral health Reduce disparities between Medicaid and non Medicaid users Children and disparities measures TBD
CSI RI Implementation Timeline Governance Structure and Process Establish Patient Advisory Group Institutionalize Learning Collaborative Infrastructure Program Evaluation Community Health Teams Increase Demand for PCMH Amongst Purchasers Expansion Access Jan. 2013 Jan. 2014 Jan. 2015 Jan. 2016 Jan. 2017 Jan. 2018 Refine Contract Develop Gain Sharing Model Price Transparency to Reduce Costs Payment Reform Impact of ACA CSI Kids Integrate with Medicaid Behavioral Health Physician Satisfaction Population Health Physician Recruitment and Retention PCMH Workforce Education and Training Workforce Development Key Lead Partner Participate 5
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Evolution of Governance Structure Steering committee initially made decisions and Executive committee small sub group to do the work Over time Executive Committee morphed into decision making body and Steering committee became more of an advisory committee Executive Committee then became the Board of Directors Board of Directors review of strategic priorities which drive managements work plan and budget 7